The Role
The FWA Analyst Intern will assist in researching and validating Fraud, Waste, and Abuse schemes, testing alerts, and ensuring quality in software development while complying with privacy standards.
Summary Generated by Built In
Healthcare Fraud Shield is seeking a part-time Fraud, Waste and Abuse (FWA) Analyst Intern for our health care Fraud, Waste and Abuse software platform. You will work with our Special Investigations Unit and IT teams on researching FWA schemes, testing, FWA validation and more. In this role, you should have a keen eye for detail and excellent communication skills. If you are also competent in executing test cases and are passionate about quality then this is the job for you.
Healthcare Fraud Shield provides a competitive salary. Benefits packages are not available to part-time employees.
Key Responsibilities
- Use knowledge of Fraud, Waste and Abuse (FWA) to research, test and identify effective alerts and algorithms targeting FWA detection and prevention on claims
- Proactively analyzes and tests output of FWA schemes and enhancements to existing FWA schemes
- Understanding of pharmacy and medical claims data analysis and quality monitoring
- Maintain alert and policy knowledgebase
- Research supporting documentation for knowledgebases by client
- Execute test cases and analyze results
- Demonstrated aptitude for problem solving and debugging
- Identify and troubleshoot issues discovered during testing and reported by customers
- Work with cross-functional teams to ensure quality throughout the software development lifecycle
- Satisfies all applicable requirements imposed by applicable Company customers, clients, or business partners, with respect to the relationship and role
- Understands and complies with all company Privacy and Security standards
- Other duties as assigned
Skills, Knowledge and Expertise
- Knowledge of healthcare Fraud, Waste and Abuse (FWA)
- Knowledge of health care, insurance, medical terminology, CPT, HCPCS, DRG, Revenue, ICD-10
- Ability to document and troubleshoot errors
- Excellent communication skills both verbally and written
- Attention to detail
- Analytical mind and problem-solving aptitude
- Excellent troubleshooting and problem solving skills
- Ability to communicate instructions in a clear and concise manner
- Comfortable multitasking in fast paced environment
- Able to work independently as well as part of a dynamic team
Preferred Skills:
- Strong communication and listening skills
- Strong analytical skills
- Strong computer skills
- Detail oriented
Benefits
- Medical, Dental & Vision insurance
- 401(k) retirement savings with employer match
- Vacation and sick paid time off
- 8 paid holidays
- Paid maternity/paternity leave
- Disability & Life insurance
- Flexible Spending Account (FSA)
- Employee Assistance Program (EAP)
- Professional and career development initiatives
- Remote work eligible
REMOTE WORK REQUIREMENTS
- Must have high speed Internet (satellite is not allowed for this role) with a minimum speed of 25mbs download and 5mbs upload.
Healthcare Fraud Shield is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
About
Healthcare Fraud Shield, headquartered in Chesterfield, MO, is a leading provider of innovative fraud, waste, and abuse (FWA) solutions for healthcare insurance payers. Since its establishment in 2011, the company has focused solely on healthcare fraud prevention and payment integrity, delivering unique advantages to its broad client base. At the heart of Healthcare Fraud Shield's offerings is FWAShield™, an integrated platform designed by industry-leading healthcare experts. This comprehensive solution includes PreShield™ (pre-payment), PostShield™ (post-payment), RxShield™ (pharmacy analytics), CaseShield™ (case management), and QueryShield™ (ad-hoc querying tool). Leveraging the latest technology available, Healthcare Fraud Shield provides the most affordable, flexible, transparent, efficient, and effective solution in the marketplace. With over 20 years of experience, the founders of Healthcare Fraud Shield are pioneers in successful fraud detection software development in the financial services industry. They have designed their suite of software to identify superior FWA rates, utilizing advanced analytics, AI, and the best exterior data. Additionally, Healthcare Fraud Shield offers expert services in detecting and verifying suspected FWA billed services, including the development of claim edit rules. Their experienced SIU team, which includes Accredited Health Care Fraud Investigators and Certified Professional Coders, delivers top-notch training throughout the country. Trust Healthcare Fraud Shield to safeguard your healthcare insurance payments and ensure payment integrity.
Skills Required
- Knowledge of healthcare Fraud, Waste and Abuse (FWA)
- Excellent communication skills both verbally and written
- Ability to document and troubleshoot errors
- Analytical mind and problem-solving aptitude
- Attention to detail
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The Company
What We Do
Healthcare Fraud Shield provides AI-powered SaaS solutions and dynamic software to detect and prevent healthcare fraud, waste, abuse, and error (FWAE) across the claims lifecycle.
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